The search for the residency program that meets the ambitions you have for your physician career can be a grueling process. But beyond comparing the merits of individual residency programs, a foundational knowledge of the five types of residency programs can boost your research to find the perfect Match.
The type of residency position you apply to can affect your application strategy, your Match rank-order list and even whether you need to match into more than one program to begin residency training. Here's a primer on the five different residency program types, how they fit into the Match and what every applicant should know before submitting applications.
Understanding categorical programs
For applicants in the Match, residency programs fall into five main types:
- Categorical.
- Categorical primary care.
- Preliminary.
- Advanced.
- Reserved—these program positions are typically unavailable to graduating medical students.
Categorical programs are the most straightforward route. These programs begin at the PGY-1 level and provide the full course of training required for board certification in a specialty. Depending on the specialty, they can last anywhere from three to seven years.
Categorical positions make up a large majority of positions in the Main Residency Match, making them the most familiar option for many students. Specialties in which all or most applicants match into categorical programs include psychiatry, family medicine, obstetrics & gynecology and most surgical fields.
A smaller subset of categorical positions are categorized as categorical primary care programs. These tracks exist only in internal medicine and pediatrics and take three years to complete. The most common preliminary specialty matches are internal medicine and general surgery.
Where it can get complicated
Advanced and preliminary positions are typically applied for in tandem.
Often listed as PGY-1 only, preliminary programs are usually a yearlong and serve as a prerequisite for advanced programs, which typically start in the second year of residency. The most common PGY-1 only tracks are in general surgery and internal medicine.
Most advanced programs begin at the PGY-2 level. That means applicants who match into an advanced specialty also need to complete a preliminary year before starting the core residency.
Advanced residency positions are common in anesthesiology, diagnostic radiology, neurology and radiation oncology. For applicants looking at those fields, it is worth noting that several of them have both categorical programs where physicians spend their entire residency in the same program and institution and advanced positions that require a year of prior training. For instance: some radiology programs are categorical, some are advanced, and some institutions offer both.
Available program types vary by specialty, and sometimes by individual residency program. That means applicants should carefully review each program's eligibility requirements before applying.
Reserve programs are less relevant to most graduating medical students. These types of programs begin at the PGY-2 level, but unlike advanced programs, they start in the year of the Match and are intended for physicians with at least a year of prior GME training.
As applicants embark on the residency application process, they should consult FREIDA™, the AMA Residency and Fellowship Database®, which is a comprehensive resource that includes information on more than 14,000 Accreditation Council for Graduate Medical Education-accredited residency programs and offers a streamlined user experience.
Program type and application strategy
For medical students applying to categorical programs, the process is rather simple. You are applying to programs that will be the only destination of your residency training.
The process differs when you apply to two program types. In practical terms, students applying to advanced specialties are often building two parallel plans: one for the specialty they ultimately want and another for the PGY-1 training that gets them there.
A former medical school dean for student affairs and professor of family medicine, David Henderson, MD, is the AMA’s vice president of medical education and workforce development.
Managing two Match tracks concurrently can make the process a bit more involved on the applicant side of things. When it comes to prioritizing the programs to which you apply, accept interview invitations and rank, more emphasis should be placed on the “the places where you are going to do the bulk of your training.”
“You generally don’t want to spend as much time knocking on preliminary doors as you do on the doors of the major disciplines,” Dr. Henderson said, adding that preliminary positions generally require less applicant bandwidth because “they are usually less competitive than positions in the primary disciplines.”
That does not mean the preliminary year should be treated as an afterthought. When evaluating options for that one-year stint, Dr. Henderson said applicants should approach it much like any other residency choice.
“You want to spend that year in a place where you’re going to be comfortable, both in the workplace and outside of it,” he said.
